New Approaches to Smoking Cessation in Heavy Drinkers

描述(申请人提供)：酗酒者的吸烟率比普通人群高两到三倍，而且在戒烟和减少饮酒方面都不太成功。在美国，这两种行为是导致发病率和死亡率的主要原因之一，当这两种行为结合在一起时，比单独使用任何一种行为都会带来更大的健康负担。尽管有这些风险，吸烟和酗酒通常不会同时治疗，现有的联合治疗效果有限。强化的综合治疗对这一人群可能是有益的，并针对潜在的抑郁和睡眠问题，这些问题经常与吸烟和酗酒同时出现，通常是在戒烟或戒酒后出现的，并促进吸烟和酒精复发。抑郁和睡眠问题要么没有在吸烟或酒精干预中得到常规解决，要么被降级到可能不会使用的选修内容。这项提案的总体目标是开发一项独立的临床研究计划，专门针对酗酒者的新型戒烟心理治疗干预措施，将其与酒精治疗相结合，并针对这一人群中潜在的抑郁症和睡眠问题。Fucito博士是一位临床心理学家，在药物滥用和特定的实验室培训以及药物治疗、临床试验和吸烟研究方面拥有广泛的临床研究背景。她在吸烟、抑郁和睡眠问题之间的联系以及吸烟在酒精治疗反应中的作用、对吸烟者的抑郁进行认知行为干预以及评估酗酒者的吸烟药物治疗方面拥有专业知识。研究计划的第一阶段将包括对已完成的戒烟临床试验的分析，以进一步检查酗酒者的吸烟复发因素，并为第二阶段干预开发提供信息。第二阶段将需要开发和评估针对吸烟和酒精的强化、综合认知-行为干预(CBT For SA)与标准吸烟咨询(SC)。针对SA的CBT将首先在10名酗酒吸烟者中试行，以完善疗程长度、内容和治疗师培训程序。随后将对40名酗酒吸烟者进行随机对照试验，以比较CBT对SA和SC的初步疗效：(1)促进戒烟；(2)减少重度饮酒的数量和频率。受指导的职业发展和研究活动旨在发展Fucito博士在以下方面的专长：(1)心理治疗疗效研究，(2)先进的纵向统计技术，(3)酒精滥用评估和治疗，以及(4)睡眠问题的分类和治疗。这些培训目标将通过：(1)课程作业，(2)与相关专家的指导和咨询，(3)临床经验，(4)通过耶鲁大学心理治疗发展中心和酒精中毒转化神经科学中心提供的研讨会和资源，以及(5)拟议的研究项目来实现。通过这一职业发展和研究，Fucito博士将更好地了解吸烟和酗酒共存的性质和治疗方法，从而为独立的职业生涯奠定基础。

DESCRIPTION (provided by applicant): Heavy drinkers smoke cigarettes at rates two to three times higher than the general population and are less successful both quitting smoking and reducing their alcohol use. The two behaviors are among the leading causes of morbidity and mortality in the United States and when combined represent a greater health burden than either alone. Despite these risks, smoking and heavy alcohol use are not typically treated concurrently and the existing combination treatments are of limited effectiveness. Intensive, integrated treatment may be beneficial for this population as well as targeting potential depression and sleep problems which frequently co- occur with smoking and heavy drinking, often emerge upon nicotine or alcohol withdrawal, and promote smoking and alcohol relapse. Depression and sleep problems are either not routinely addressed in smoking or alcohol interventions or relegated to elective content that may not be used. The overall goal of this proposal is to develop an independent clinical research program specializing in novel smoking cessation psychotherapy interventions for heavy drinkers that are integrated with alcohol treatment and target potential depression and sleep problems in this population. Dr. Fucito is a clinical psychologist with a broad clinical research background in substance abuse and specific training in laboratory and pharmacotherapy clinical trial smoking research. She has expertise in the associations among smoking, depression, and sleep problems and the role of smoking in alcohol treatment response, conducting cognitive- behavioral interventions for depression in smokers, and evaluating smoking pharmacotherapy treatment for heavy drinkers. Phase 1 of the research plan will involve analyses of completed smoking cessation clinical trials to further examine smoking relapse factors in heavy drinkers and inform Phase 2 intervention development. Phase 2 will entail the development and evaluation of an intensive, integrated cognitive-behavioral intervention for smoking and alcohol (CBT for SA) versus standard smoking counseling (SC) in heavy drinkers. CBT for SA will first be piloted with 10 heavy drinking smokers to refine session length and content and therapist training procedures. A randomized controlled trial with 40 heavy drinking smokers will then be conducted to compare the preliminary efficacy of CBT for SA versus SC for: (1) promoting smoking abstinence and (2) reducing the quantity and frequency of heavy drinking. Mentored career development and research activities are designed to develop Dr. Fucito's expertise in: (1) psychotherapy efficacy research, (2) advanced, longitudinal statistical techniques, (3) alcohol misuse assessment and treatment, and (4) classification and treatment of sleep problems. These training goals will be achieved through: (1) coursework, (2) mentorship and consultation with relevant experts, (3) clinical experiences, (4) seminars and resources available through the Yale Psychotherapy Development Center and Center for the Translational Neuroscience of Alcoholism, and (5) the proposed research projects. Through this career development and research, Dr. Fucito will acquire a better understanding of the nature and treatment of co-occurring cigarette smoking and heavy drinking to inform an independent career.